Provider Demographics
NPI:1568575421
Name:WILLIAN, EVAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:R
Last Name:WILLIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-1630
Mailing Address - Country:US
Mailing Address - Phone:903-856-3665
Mailing Address - Fax:903-856-3692
Practice Address - Street 1:210 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1630
Practice Address - Country:US
Practice Address - Phone:903-856-3665
Practice Address - Fax:903-856-3692
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608213OtherBCBS
TX615276OtherACN
TX4631607OtherAETNA
TX4631607OtherAETNA
TX615276OtherACN